Thread by @ChrisCEOHopson

How’s NHS? Staff completely flat out & beyond full stretch. Busier than ever before at this time of year. Major workforce/demand challenges. Before full impact of winter/omicron. Worrying. But as committed as ever to providing outstanding patient care to all who need it!🧵. 1/25

Five features of current pressures, each explored below. 1. NHS staff working very hard delivering high levels of activity despite context/constraints. 2. Pressure universal across entire health & care system. 3. Pattern of pressure very different to this time last year...2/25

…NHS currently has lower covid caseload but experiencing more extended/universal pressure. 4. Workforce challenges wide ranging & difficult to address. 5. NHS beyond full stretch before we have reached traditional winter peak which could coincide with Omicron peak 3/25

1. This week’s NHS statistics show two things happening at the same time. Frontline NHS staff are working flat out and delivering very high levels of activity despite being very tired. But, given scale of demand, performance is under huge pressure and deteriorating…4/25

…Second busiest ever November for A&E attendances – 500,000 more than this time last year. Highest number of November 999 calls ever. 150,000 more elective treatment starts in October vs last year. Mental health referrals up 12% & care contacts up 10% vs previous month…5/25

… Community services e.g. rehabilitation, step down discharge and vaccination co-ordination at full stretch. Activity levels delivered across all sectors impressive given extensive workforce pressures & significant lost capacity due to covid infection control constraints…6/25

But, despite frontline effort, elective surgery waiting list has increased to 6 million (up 2.4% compared to last month). And the number of patients waiting more than 12 hours in A&E worryingly up to over 10,500 (the highest ever monthly figure and up 50% vs last month)…7/25

First set of weekly winter stats also show scale of pressure vs same week last year. Bed occupancy at 94% vs last year’s 87%. Adult critical care occupancy 81% vs 74%. Ambulance handover delays longer: %age of 30 minute plus waits risen from 11% last year to 20% this year. 8/25.

2. Pressure now universally high across entire health and care system. Primary care flat out with ‘normal’ work but now have booster campaign extension to deliver – a massive increase in workload. Social care has also seen a huge increase in pressure over last few months… 9/25

EG 1.5m hours of domiciliary care Aug-Oct couldn’t be delivered due to lack of care staff. Social care workforce reduced by 50-70k (3-4%) May-October. Big (but not only) driver of delayed hospital discharges: 10.5k (11%) beds occupied by medically fit patients last week…10/25

Highlighting need for permanent discharge funding. NHS trusts rightly working hard to support social care colleagues as much as possible. Including transferring staff, transferring NHS budget, employing staff on NHS terms and conditions and seconding staff to social care... 11/25

Similar pressures in other parts of NHS including mental health and community services. Both, for example, under significant pressure from very hot urgent care pathway and from significant care backlogs. Still under-measured/reported, risking increased health inequalities 12/25

3. Important to understand pattern and duration of these pressures are very different to Jan 2021 NHS experience. I’m currently being asked a lot: “why can’t NHS cope with this pressure when it did so well in January 2021, e.g. 34,000 covid-19 in hospitals vs 5,000 now?"…13/25

Jan 2021 covid peak was significantly dealt with by delaying elective activity we can no longer afford to delay. EG one CEO told me that 12 of last week’s A&E admitted emergency surgery patients had been on their waiting lists and had turned into emergency cases... 14/25

Jan 2021 Covid-19 peak was really tough but came and went relatively quickly. This is pressure for months on end. As latest stats show, urgent & emergency care now under much greater pressure. As are primary care (vax effort now larger/more complex) and social care…15/25

We need to stop just looking at covid-19 caseload and pretending that, by itself, this is an accurate measure of NHS pressure. And we should stop comparing Jan 2021 with Dec 2021. All the evidence suggests that NHS is under unprecedented pressure for this time of year. 16/25

4. In addition to demand challenges, trusts reporting very significant workforce challenges. Consistently mentioned by trust CEOs as their biggest current problem, irrespective of trust type. Six problems. Difficulties in recruitment with nearly 100,000 NHS vacancies… 17/25

Loss of staff to retail, hospitality & logistics sectors paying significant sign on bonuses & higher comparative wages. Staff choosing to retire early / return to their countries of origin including worrying loss of experience and leadership from senior staff departures…18/25

Growing levels of sickness absence due to consistent high level of pressure staff are under. Increasing difficulty in securing staff to work bank and agency shifts on which the NHS has become worryingly reliant as trusts have to protect their staff’s health and wellbeing…19/25

Pressure on morale as staff say they can't give the quality of care they want to provide and they believe patients need. Given the size of the future task to cut growing care backlogs, staff are really worried that the current level of pressure will become ‘normalised’… 20/25

All these problems difficult to address in short term. They're equally, if not more, present in the social care sector. Reinforces, again, the need for proper and effective long term workforce planning across the health and care system. Current approach unsustainable. 21/25

5. Struck by how many long serving CEOs are saying that this is clearly, and incontrovertibly, the highest and longest sustained period of pressure they have seen in their careers. They are also worried that this is occurring before the traditional January winter peak…22/25

And at a time when they don’t yet know what extra covid caseload will come from omicron. And there seems to be a good chance that an omicron peak may fall in exactly the same early to mid January time period. They are, though, very determined to do four things… 23/25

Trust leaders determined to: support staff to provide best possible care; focus on patient safety, helping clinicians prioritise by clinical need; be ready to rapidly expand capacity as they did last January; work as health & care system, supporting colleagues when needed. 24/25

SUMMARY. NHS is experiencing significantly higher pressure than we have ever seen before at this time of year. This is putting pressure on staff, quality of care and patient safety. But everyone in NHS working flat out to deliver best possible care to all those who need it. 25/25